Surgical outcomes in gynaecological oncology

Presently there are no reliable statistics available on complication rates associated with surgery in gynaecological cancer in the UK, apart from data from small studies involving individual centres and clinical trials. This thesis describes the United Kingdom Gynaecological Oncology Surgical Outcomes and Complications study (UKGOSOC) that was set up to prospectively capture data from ten UK gynaecological cancer centres on surgical procedures and complications in a uniform manner using agreed definitions so that data could be analysed and compared. A web-based database was set up to capture surgery and complications contemporaneously from the hospitals, and, consented women were sent a follow-up letter eight weeks postoperatively. Intraoperative and postoperative complications were recorded using a pre-determined list. Postoperative complications were graded (I-V) in increasing severity using the Clavien-Dindo system. Grade I complications were excluded from analysis. Univariable and multivariable regression analyses were performed to determine the predictors for intraoperative and postoperative complications. The Lasso method of penalised regression was used to create a risk-prediction model for comparing outcomes between the centres. Data on 2948 eligible major surgical procedures were analysed and 1462 follow-up letters were received. The overall intraoperative complication rate was 4.7% (95% CI 4.0-5.6). The hospital-reported postoperative complication rate was 14.4% (95% CI 13.2-15.7) which increased to 25.9% (95% CI 23.7-28.2) when both hospital and patient- reported postoperative complications were included. The predictors for intraoperative and postoperative complications were different apart from diabetes which was common to both. Risk-adjustment had a modest effect on the complication rates for individual centres but allowed for a fairer comparison. There was no concordance between the ranking order of the centres for intraoperative and postoperative complication rates. The overall intraoperative (≈5%) and postoperative (≈26%) complication rates and funnel graphs derived from this study could be used to benchmark performance of gynaecological oncology centres and even individual surgeons if a larger dataset becomes available nationally.